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General NPI Number Information
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NPI Number | 1780416362
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Entity Type | Organization
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Legal Business Name | MCR DENTAL SERVICES LLC
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | CARR. 308 KM. 0.0, INT. CARR. 103, EDIF. #833
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City | CABO ROJO
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State | PR
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Zip | 00623
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Country | US
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Telephone | 787-255-3486
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 573
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City | BOQUERON
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State | PR
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Zip | 00622
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Country | US
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Telephone | 787-255-3486
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Fax |
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR & DENTIST
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Name | DR. MAYRA CAMACHO ROLDOS
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Credential | DMD
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Telephone | 787-255-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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